MEDICARE: PROF. WASHINGTON CULLAMPE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	49507	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D49507	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1881738094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. WASHINGTON CULLAMPE DDS

Provider Business Mailing Address
First Line	:	2055 N PERRIS BLVD
Second Line	:	STE E-12
City	:	PERRIS
State	:	CA
Zip	:	92571-2509
Country	:	US
Telephone Number	:	951-657-9965
Fax Number	:	951-657-6682

Provider Business Practice Location Address
First Line	:	2055 N PERRIS BLVD
Second Line	:	STE E-12
City	:	PERRIS
State	:	CA
Zip	:	92571-2509
Country	:	US
Telephone Number	:	951-657-9965
Fax Number	:	951-657-6682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	08/02/2011

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